Classification of drug-related problems with new prescriptions using a modified PCNE classification system Patrick M. Eichenberger Markus L. Lampert Irene Vogel Kahmann J. W. Foppe van Mil Kurt E. Hersberger Email author Research Article First Online: 13 March 2010 Received: 29 September 2009 Accepted: 24 February 2010
17
Citations
647
Downloads
Abstract Objectives To explore and classify drug-related problems (DRPs) with new prescriptions detected in community pharmacies using a modified PCNE (Pharmaceutical Care Network Europe) classification system. Setting Sixty-four Swiss community pharmacies offering internships for pharmacy students. Main outcome measures Occurrence, nature and pharmacist’s management of DRPs. Methods Fifth-year pharmacy students collected consecutively hospital discharge and primary care prescriptions. After training, they documented clinical and technical DRPs, causes and interventions. Results Prescriptions of 616 patients (43.0% discharged from hospital) were analysed. The patients’ median age was 56 years and they received a median of 3 (range 2–19) different drugs. In 121 (19.6%) prescriptions 141 clinical DRPs were detected. The most frequent clinical DRPs were potential drug–drug interactions (DDIs) (37.6%), drug choice (24.8%) and drug use problems (15.6%). These clinical DRPs led to a total of 299 interventions. There were 222 prescriptions (36.0%) that showed 278 technical DRPs, resulting in a total of 417 interventions. Most frequent technical DRPs were missing or unclear package size or therapy duration (32.7%) and missing or unclear dosing/application instructions (30.9%). Most DRPs (75.4%) could be managed by the pharmacist alone. The number of prescribed drugs was the main factor with an influence on the frequency of clinical and technical DRPs. Conclusion Clinical and technical DRPs are frequently observed in primary care as well as in hospital discharge prescriptions. The modified PCNE classification system, especially the amendment with a technical DRP category, proved to be useful and allowed the classification of all DRPs. Neither the setting (hospital discharge vs. primary care) nor the quality of electronically printed prescriptions, but only the number of prescribed drugs influenced the occurrence of clinical or technical DRPs.
Keywords Classification system Community pharmacy Drug-related problems Hospital discharge PCNE Pharmaceutical care Primary care Switzerland
References 1.
Westerlund LT, Almarsdottir AB, Melander A. Drug-related problems and pharmacy interventions in community practice. Int J Pharm Pract. 1999;7(11):40–50.
Google Scholar 2.
Ernst ME, Iyer SS, Doucette WR. Drug-related problems and quality of life in arthritis and low back pain sufferers. Value Health. 2003;6(1):51–8.
CrossRef PubMed Google Scholar 3.
Triller DM, Clause SL, Briceland LL, Hamilton RA. Resolution of drug-related problems in home care patients through a pharmacy referral service. Am J Health Syst Pharm. 2003;60(9):905–10.
PubMed Google Scholar 4.
Paulino EI, Bouvy ML, Gastelurrutia MA, Guerreiro M, Buurma H. Drug related problems identified by European community pharmacists in patients discharged from hospital. Pharm World Sci. 2004;26(6):353–60.
PubMed Google Scholar 5.
Hammerlein A, Griese N, Schulz M. Survey of drug-related problems identified by community pharmacies. Ann Pharmacother. 2007;41(11):1825–32.
CrossRef PubMed Google Scholar 6.
Krahenbuhl-Melcher A, Schlienger R, Lampert M, Haschke M, Drewe J, Krahenbuhl S. Drug-related problems in hospitals: a review of the recent literature. Drug Saf. 2007;30(5):379–407.
CrossRef PubMed Google Scholar 7.
Howard R, Avery A, Bissell P. Causes of preventable drug-related hospital admissions: a qualitative study. Qual Saf Health Care. 2008;17(2):109–16.
CrossRef PubMed Google Scholar 8.
Krahenbuhl JM, Kremer B, Guignard B, Bugnon O. Practical evaluation of the drug-related problem management process in Swiss community pharmacies. Pharm World Sci. 2008;30(6):777–86.
CrossRef PubMed Google Scholar 9.
Lampert ML, Kraehenbuehl S, Hug BL. Drug-related problems: evaluation of a classification system in the daily practice of a Swiss University Hospital. Pharm World Sci. 2008;30(6):768–76.
CrossRef PubMed Google Scholar 10.
Patel P, Zed PJ. Drug-related visits to the emergency department: how big is the problem? Pharmacotherapy. 2002;22(7):915–23.
CrossRef PubMed Google Scholar 11.
Becker ML, Kallewaard M, Caspers PW, Visser LE, Leufkens HG, Stricker BH. Hospitalisations and emergency department visits due to drug-drug interactions: a literature review. Pharmacoepidemiol Drug Saf. 2007;16(6):641–51.
CrossRef PubMed Google Scholar 12.
Rupp MT, DeYoung M, Schondelmeyer SW. Prescribing problems and pharmacist interventions in community practice. Med Care. 1992;30(10):926–40.
CrossRef PubMed Google Scholar 13.
Smith CP, Christensen DB. Identification and clarification of drug therapy problems by Indian health service pharmacists. Ann Pharmacother. 1996;30(2):119–24.
PubMed Google Scholar 14.
Blix HS, Viktil KK, Reikvam A, Moger TA, Hjemaas BJ, Pretsch P, et al. The majority of hospitalised patients have drug-related problems: results from a prospective study in general hospitals. Eur J Clin Pharmacol. 2004;60(9):651–8.
CrossRef PubMed Google Scholar 15.
Viktil KK, Blix HS, Moger TA, Reikvam A. Interview of patients by pharmacists contributes significantly to the identification of drug-related problems (DRPs). Pharmacoepidemiol Drug Saf. 2006;15(9):667–74.
CrossRef PubMed Google Scholar 16.
Shalansky S, Nakagawa R, Wee A. Drug-related problems identified and resolved using pharmaceutical care versus traditional clinical monitoring. Can J Hosp Pharm. 1996;49(6):7.
Google Scholar 17.
Hanlon JT, Lindblad CI, Gray SL. Can clinical pharmacy services have a positive impact on drug-related problems and health outcomes in community-based older adults? Am J Geriatr Pharmacother. 2004;2(1):3–13.
CrossRef PubMed Google Scholar 18.
Barber N, Parsons J, Clifford S, Darracott R, Horne R. Patients’ problems with new medication for chronic conditions. Qual Saf Health Care. 2004;13(3):172–5.
CrossRef PubMed Google Scholar 19.
PCNE. The PCNE Classification V 5.01 2006 29 May 2006 [cited 20 Sep 2009]. Available from:
http://www.pcne.org/dokumenter/DRP/PCNE%20classification%20V5.01.pdf .
20.
Hersberger K, Botomino A, Sarkar R, Tschudi P, Bucher H, Briel M. Prescribed medications and pharmacy interventions for acute respiratory tract infections in Swiss primary care. J Clin Pharm Ther. 2009;34(4):387–95.
CrossRef PubMed Google Scholar 21.
AbuRuz SM, Bulatova NR, Yousef AM. Validation of a comprehensive classification tool for treatment-related problems. Pharm World Sci. 2006;28(4):222–32.
CrossRef PubMed Google Scholar 22.
Westerlund LT, Marklund BR, Handl WH, Thunberg ME, Allebeck P. Nonprescription drug-related problems and pharmacy interventions. Ann Pharmacother. 2001;35(11):1343–9.
CrossRef PubMed Google Scholar 23.
Eccles M, Grimshaw J, Campbell M, Ramsay C. Research designs for studies evaluating the effectiveness of change and improvement strategies. Qual Saf Health Care. 2003;12(1):47–52.
CrossRef PubMed Google Scholar 24.
Allenet B, Bedouch P, Rose FX, Escofier L, Roubille R, Charpiat B, et al. Validation of an instrument for the documentation of clinical pharmacists’ interventions. Pharm World Sci. 2006;28(4):181–8.
CrossRef PubMed Google Scholar 25.
Knapp KK, Katzman H, Hambright JS, Albrant DH. Community pharmacist interventions in a capitated pharmacy benefit contract. Am J Health Syst Pharm. 1998;55(11):1141–5.
PubMed Google Scholar 26.
Leemans L, Veroeveren L, Bulens J, Hendrickx C, Keyenberg W, Niesten F, et al. Frequency and trends of interventions of prescriptions in Flemish community pharmacies. Pharm World Sci. 2003;25(2):65–9.
CrossRef PubMed Google Scholar 27.
Schaefer M. Discussing basic principles for a coding system of drug-related problems: the case of PI-Doc. Pharm World Sci. 2002;24(4):120–7.
CrossRef PubMed Google Scholar 28.
Benrimoj SI, Langford JH, Berry G, Collins D, Lauchlan R, Stewart K, et al. Economic impact of increased clinical intervention rates in community pharmacy. A randomised trial of the effect of education and a professional allowance. Pharmacoeconomics. 2000;18(5):459–68.
CrossRef PubMed Google Scholar 29.
Currie JD, Chrischilles EA, Kuehl AK, Buser RA. Effect of a training program on community pharmacists’ detection of and intervention in drug-related problems. J Am Pharm Assoc (Wash). 1997;NS37(2):182–91.
Google Scholar © Springer Science+Business Media B.V. 2010
Authors and Affiliations Patrick M. Eichenberger Markus L. Lampert Irene Vogel Kahmann J. W. Foppe van Mil Kurt E. Hersberger Email author 1. Pharmaceutical Care Research Group University of Basel Basel Switzerland 2. Clinical and Hospital Pharmacy Cantonal Hospital Bruderholz Bruderholz Switzerland 3. Clinical and Hospital Pharmacy Cantonal Hospital Schaffhausen Schaffhausen Switzerland 4. van Mil Consultancy Zuidlaren Netherlands